Q3_SS_2015_Blasenkarzinom

Blasenkarzinom
Urologische Krebsarten
Testis Penis
1%
6%
Kidney
19%
Prostate
41%
Bladder
33%
Epidemiologie
Blasenkarzinom in Europa
•5th most common cancer in Europe 1
•100,900 newly diagnosed cases
•37,100 deaths
Numbers
of newlyof
diagnosed
cases
of cancer
in the
Numbers
deaths from
cancer
EU-25
countries (2000
2
2
EU by cancer estimates)
site (2000 estimates)
Bowel
Lung
Female
breast
Bowel
Lung
Breast
Prostate
Stomach
Bladder
Prostate
Stomach
Pancreas
LiverOral
BladderNHL
Kidney
Leukaemia
Uterus
NHL
Pancreas
Ovary
Leukaemia
Kidney
Melanoma
Oesophagus
Ovary
Oral
Liver
Brain and CNS
Cervix
Multiple myeloma
Cervix
Brain and
CNS
Larynx
Larynx
Uterus
Oesophagus
Melanoma
Multiple
myeloma
Thyroid
Thyroid
Hodgkin's
Testis
Testis
Hodgkin's
Other
Other
1)
2)
231,500
258,000
244,600
138,400
243,600
91,000
157,400
78,100
100,900
66,500
95,500
54,300
66,500
40,200
37,10059,400
55,600
35,300
49,500
28,900
48,700
28,100
47,200
27,900
41,400
27,300
41,100
26,100
34,900
25,800
34,500
16,400
34,100
15,600
14,900
31,400
11,700
29,300
21,000
10,800
4,000
17,100
3,700
14,700
1,100
12,400
141,200
153,800
European Cancer Leagues Cancer in Europe Facts and Figures January 2005
Cancer Research UK Cancer statistics: Cancer in the EU
Krebsneuerkrankungen in
Deutschland/Jahr
Quelle: Robert-Koch-Institut, 2006
Blasenkarzinom vs. Alter
Numbers of cases and age-specific incidence rates,
bladder cancer, by sex, UK, 2004
2
1,500
300
Male cases
1,250
250
Male rates
1,000
200
750
150
500
100
250
50
Age at diagnosis
1)
2)
3)
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
0
5-9
0
0-4
Number of cases
Female rates
Rate per 100,000 population
Female cases
European Cancer Leagues Cancer in Europe Facts and Figures
January 2005
Cancer Research UK Cancer statistics: Cancer in the EU
Boyle & Ferlay Annals of Oncology 2005; 16: 481
Risikofaktoren
Europa: 50%
 Nikotingenuss +/- Umweltgifte
Blasenkarzinom: Risikofaktoren
TCC Induktion
Risiko Faktor
Rauchen
Tod durch TCC 47% Männer
37% Frauen
Medikamente
Familiäre
Prädisposition
Entzündung
Phenacetin,
Cyclophosphamide
ja
möglich
Schistosoma haematobium
?
?
Coffein
Arylamine
ja
Faktor 3-6
Farben-,Textil-, chemische
und Gummi-Industrie
ja
Faktor (?)
Adapted from: Negri, Eur J Cancer Prev, 2001
aromatische Amine und BCa:
4-Aminobiphenyl, Benzidin, ß-Naphthylamin
(4-Chlor-o-Toluidin)
• mittlere Expositionszeit: 21Jahre
• mittlere Latenz: 37Jahre
• Mittleres Alter bei Erkrankungsbeginn
66 Jahre
• SKR: Inzidenzgipfel >70a
adaptiert nach:
Zweitkarzinome nach
Beckenbestrahlung:
am häufigsten Blase, Rektum
JCNI, Vol. 99 (21), 1634-1643, 2007
Diagnose
•
•
•
•
Hämaturie
Rez. HWI
Bildgebung  Ultraschall, CT, MRT
Harntumormarker
– Zytologie
– Proteomics, Genomics
• Endoskopie
Harn-Tumormarker
Cell surface
Antigen
Genetische
Aberrationen (FISH)
Nuclear
Matrix
Protein 22
(Human) Complement
Factor H
Urothelzelle im Harn
Sensitivität:NMP 22 BladderChek vs. Zytologie
Diagnose
© Päulgen 2003
© Matritech
HB Grossman, JAMA, 295(3), 2006
Aus wie vielen Zellen
besteht dieser Tumor?
1cm
9
ca. 10 Zellen
Blasenkarzinom: TNM
pTis
pTa
pT1
30-35 %
25-30 %
“oberflächliches“
Nicht
muskelinvasives
Blasenkarzinom
pT2a
pT2b
pT3a
pT3b
pT4
30-35 %
muskelinvasives
Blasenkarzinom
T2-4
Ta G1
Ta G1
Ta, T1 G2-3
T2-4
Ta, T1 G2-3
Therapie
TransUrethrale Resektion Blase (TUR-B)
TransUrethrale Resektion Blase (TUR-B)
Therapie des fortgeschrittenen
Blasenkarzinoms
Neoadjuv.
Chemo
Definitive Tx:
Solo
+/- Cystectomy
+/- (Radx)
Blasenerhalt ?
Adjuv.
Chemo
Bladder Substitution – Tuebingen Technique
40 cm
Therapie des fortgeschrittenen
Blasenkarzinoms
Neoadjuv.
Chemo
Definitive Tx:
Solo
Chemo
+/- Cystectomy
+/- (Radx)
Adjuv.
Radiatio
Chemo